Clinical outcomes one year after a digital musculoskeletal (MSK) program: an observational, longitudinal study with nonparticipant comparison group

Abstract

Background The evidence base for the impact of digital health on musculoskeletal (MSK) outcomes is growing, but it is unclear how much digital MSK programs address pain and function in the intermediate and long term. Methods This observational study of digital MSK program participants versus nonparticipants (n = 2570) examined pain, function, depression, and anxiety at 3, 6, and 12 months, and health care use at 12 months. The intervention group engaged in a digital MSK program that included exercise, education, and coaching for at least 3 months. The nonparticipant group registered, but never started the program. We collected data in app or by emailed survey at 3, 6, and 12 months after registering for the program. We conducted descriptive analyses and unadjusted and adjusted regression modeling. Results The odds ratio of achieving a minimally clinically important difference (MCID) in pain improvement for the intervention versus the nonparticipant group was 1.97 (95% CI: 1.28, 3.02; p = .002) at 3 months, 1.44 (95% CI: 0.91, 2.25; p = .11) at 6 months, and 2.06 (95% CI: 1.38, 3.08; p = .004) at 12 months in adjusted models. The odds ratio of achieving a MCID in functional improvement for the intervention versus the nonparticipant group was 1.56 (95% CI: 1.03, 2.38; p = .01) at 3 months, 1.55 (95% CI: 1.02, 2.37; p = .04) at 6 months, and 1.35 (95% CI: 0.89, 2.06, p = 0.16) at 12 months in adjusted models. For those with moderate to severe depression or anxiety at baseline, we observed statistically significant lower odds of moderate to severe depression or anxiety at 3 months, 6 months, and 12 months for the intervention versus the nonparticipant group in adjusted models (p < .05). At 12 months, the percentage with invasive, imaging, and conservative services was higher for the nonparticipant versus intervention group by 5.7, 8.1, and 16.7 percentage points, respectively (p < 0.05). Conclusions A digital MSK program may offer participants sustained improvement in pain, depression, and anxiety with concomitant decreases in health care use.

Impacts of Digital Care Programs for Musculoskeletal Conditions on Depression and Work Productivity: Longitudinal Cohort Study

“…The observed improvements in mental health scores were higher than those previously reported by other multimodal telerehabilitation interventions [69,70], and were in line with those previously reported by us [37,39] and others [27,32,34,71]. Similar to the present study, Wang et al [71] reported a significant decrease in anxiety symptoms, allowing the transition to a lower level of anxiety according to established thresholds after a telerehabilitation program combining exercise with coaching.…”

Long-Term Clinical Outcomes of a Remote Digital Musculoskeletal Program: An Ad Hoc Analysis from a Longitudinal Study with a Non-Participant Comparison Group

“…In the present study, pain levels reported by both groups at baseline (4.6–4.8 points) were within the range of those described in the literature for CMP both in telerehabilitation (5.8–4.5 points) [ 31 , 32 , 33 , 34 , 52 , 53 , 89 ] and in conventional physical therapy (4.6–5.8 points) studies [ 90 , 91 , 92 ]. When analyzing the impact of telerehabilitation interventions on pain reduction at 1-year, the results varied, possibly depending on a number of factors, including baseline pain severity, type of pain management strategy, length of the intervention and particularly the affected joint (e.g., several anatomic regions (50.9%) [ 31 ], low back (44.8%) [ 93 ], knee (43.9%) [ 32 ], hip (34.5%) [ 32 ], or hip and knee (17.2%) [ 94 ]). In the present study, a 2.43-points change was observed, with the comparison group reporting significantly lower improvement.…”

“…Furthermore, digital interventions allow easy delivery of multimodal approaches, highly recommended for CMP [ 6 , 29 ]. Telerehabilitation for CMP has shown comparable results to in-person physical therapy [ 30 , 31 , 32 , 33 , 34 , 35 ], while reducing costs [ 36 , 37 , 38 ]. Patient participation [ 39 ] and adherence [ 40 ] may also be maximized through these approaches.…”

“…Although there is growing evidence for the impact of digital health interventions on MSK outcomes, most trials focus on short or medium-term outcomes [ 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ], leaving a gap in the long-term impact of digital interventions on CMP [ 31 , 32 , 33 , 34 , 35 ].…”

The impact of a gamified intervention on daily steps in real-life conditions: a retrospective analysis of 4800 individuals

“…13 Some participants registered for the program, created their account, but did not take part in the intervention (i.e., did not completed any game). These individuals were considered "nonparticipants" and were used as a control group (as proposed in previous research 14 ). Similarly, the baseline period of these nonparticipants corresponds to the days prior to the date they were supposed to start the intervention period.…”